Syndemic conditions and resilience factors among Tanzanian men who have sex with men (MSM): Pathways towards a strength-based HIV intervention

Adeniyi Abolaji Adeboye, The University of Texas School of Public Health


Men who have sex with men (MSM) in Tanzania are not only disproportionately affected by HIV but also exposed to psychosocial health problems. Tanzanian MSM, like those in other resource-constrained and rights-challenged countries in Sub-Saharan Africa (SSA), are confronted with HIV-related adversities contextualized by rights-challenged and pervasively homophobic environments. These men are also socially marginalized—systematically excluded from HIV interventions and denied access to health services—in a way that threatens the possibility of achieving an AIDS-free generation in Tanzania. However, the protective and resilience factors that these men employ to survive these HIV-related adversities remain undermined.^ First data on demographic characteristics, HIV prevalence and risks among 300 Tanzanian MSM residing in Dar es Salaam and Tanga were used to examine whether there were additive interactions between five psychosocial health problems coined SAVID (substance abuse, adolescent sexual abuse, violence, internalized homonegativity and depression), that increased the odd of HIV seropositivity and HIV risk. The data also offered opportunity to explore potential resilience factors that buffered effects of SAVID on HIV seropositivity and risk among Tanzanian MSM.^ This is the first study of SSA that extended the utility of syndemic theory to offer theoretically sound understanding of HIV dynamics among MSM in Tanzania.^ It is also the first study from sub-Saharan Africa that explored the utility of resilience theory to identify potential resilience factors that conferred buffering effects on HIV infection and risks among Tanzanian MSM. ^ Literature review provided empirical evidence to support HIV disparity, existence of psychosocial health problems and their associations with HIV seropositivity and risk among SSA MSM. Previous studies were also reviewed to identify existing socio-culturally related coping strategies employed by SSA MSM to survive in hostile environment as a way of reinforcing strength-based approach to HIV intervention targeting SSA MSM.^ Using a syndemic framework, analyses were carried out to examine the additive or synergistic effects of SAVID on HIV seroprevalence and risk among Tanzanian MSM. From the perspective of resilience theory, further analyses were carried to determine potential resilience factors that buffer effects of SAVID on HIV infections and risks in the sample of Tanzanian MSM.^ Outcomes of the analyses revealed significant additive effects of SAVID on HIV infection and risks. While controlling for other demographic factors, SAVID syndemic variable was observed to increase the odds of HIV seropositivity and risks among Tanzanian MSM. While moderating effects analyses revealed formal social visibility among acquaintances buffering the impact of SAVID on HIV infection, early age (less than 15) at awareness of sexual orientation, formal social visibility among acquaintances and functional support directly conferred protection on HIV and not on HIV risk.^ Findings from this study are of great relevance in public health discourse on strength-based approach to HIV prevention program strategically needed to promote the health of socially marginalized group like Tanzanian MSM. Results from this study also present syndemic framework as a novel approach to understand dynamics of HIV infection and risks among marginalized MSM groups living in homophobic environment. The findings also signify the importance of harnessing naturally-occurring resilience factors, through strength-based HIV preventive efforts as a way of designing meaningful intervention for SSA MSM.^

Subject Area

African studies|Public health|Health education

Recommended Citation

Adeboye, Adeniyi Abolaji, "Syndemic conditions and resilience factors among Tanzanian men who have sex with men (MSM): Pathways towards a strength-based HIV intervention" (2015). Texas Medical Center Dissertations (via ProQuest). AAI10027847.